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Special Issues of People Who are Homeless
Dr. Dawn-Elise Snipes PhD, LPC-MHSP
– Explore the prevalence of homelessness for children and people with mental illness
– Discuss causes of homelessness
– Explore the relationship between homelessness and ACEs
– Discuss how homelessness impacts the HPA Axis
– Review areas to be screened
– Identify creative interventions
– Identify resources to help people access needed services

– Behavior is communication. Most people do not “choose” to be homeless.
– 25% of people who are homeless have a SPMI
– On any given night approximately 15,000 people in families are living on the street, in a car, or in another place not meant for human habitation
– Family shelters are often large houses where the entire family stays in one room.
– There is no privacy or safe place for children to play, and boys over the age of 12 are often not permitted.
– If families do not quickly find permanent housing 40 to 50% will break up within 5 years

– In the 2016-17 school year
– 1.4 million students (ages 6 to 18) experienced homelessness.
– Most students experiencing homelessness were doubling up with other families during the 2016-17 school year (75 percent), while others were in shelters (15 percent), hotels/motels (7 percent), or were unsheltered (4 percent)

– Causes of family homelessness
– When compared to low-income families, children experiencing homelessness:
• Have higher levels of emotional and behavioral problems
• Developmental delays
• Have increased risk of serious health problems
• Are more likely to be separated from their families
• Fear of DCF interference often prevents families from accessing resources
• Experience more school mobility, repeat a grade, be expelled or drop out of school, and have lower academic performance

Case Examples
– J has paranoid schizophrenia and discontinued his meds because of the side effects
– Jack got divorced and could barely afford housing and child support when his car died (which he needed to get to work in a town with no public transportation)
– June and her infant were kicked out of the house by her parents after she gave birth
– Celina and Carl were doing okay until Carl was laid off from his $20/hour job and all he could find was a minimum wage job.
– Jennifer and her daughter were abandoned by her daughter’s dad. Jennifer could not pay the rent. The section 8 list was closed for the year
Case Examples
– Sally and her daughter left a violent situation
– Tina had a car accident and now suffers excruciating chronic pain and is unable to work. She has applied for SSDI, but is on her third appeal.
– John ran away from home due to abuse. He has had to be creative to survive. He does not qualify for Medicaid or TANF because he has no children. He is clinically depressed and shame keeps him from asking for help.
– John was driving home after having dinner with friends. His blood alcohol was 0.09. He got in an accident. Arrested for DUI. Lost his job.
– Bobby and Buck’s teenage son got into legal trouble. They took a second mortgage out on their house to pay the attorney fees, but soon after Buck got cancer and could not work.
Homelessness & ACES
– Abuse or neglect (even unintentional)
– Caregiver with a mental health or substance abuse issue
– Separation from caregiver (Jail, death, hospitalization, foster care)
How Does Homelessness Trigger the HPA-Axis
– Safety
– Lack of quality sleep
– Shame
– Guilt
– Anger
– Depression
– Poor nutrition
– Trauma
Assessment Needs for Homeless Persons
– Homelessness History
– Opinions/Motivations
– Mental Health and Substance Abuse History
– Education/Employment Hx

– Basic Needs (Clothes, shelter, nutrition, medical, hygiene)
– Aptitudes (Education/Employment Hx)
– Salary/Income
– Engagement
– Social Support

Homelessness & Medication
– Reduced medicine compliance (injectables-)
– Dehydration (antipsychotics, SSRIs, NSAIDs, mood stabilizers)
– Reduced ability to sweat (antipsychotics, SSRIs, allergy medications) and increased risk of heat stroke
– More difficult to control diabetes and insulin levels
– Exposure to extreme heat can reduce effectiveness
Outreach Tips
– Know people’s personal narrative—They already probably feel disenfranchised, stigmatized and overlooked
– Identify their goal’s and wants
– Reputation, approachability and visibility are key. The same person/people need to come back on a regular basis.
– Use Motivational Interviewing: FRAMEShomeless chil
Services for Children & Families
– Employment / Federal Bonding Program
– Medicaid

Creative Interventions
– Interfaith Hospitality Network
– Food/water/toiletries brought to encampments weekly (same time, same place)
– Dinner and overnight shelter in churches and community centers
– Truck stops and other places where people can shower
– Community Gardens
– Sanitation Stations
– Shelter supported Flea/Tick/Heartworm prevention and spay/neuter services
– Free mobile clinics staffed by volunteer professionals (CEU compensation)
– Residential/Level 3 Recovery Houses accepting children


– Homelessness can happen to anyone given the right circumstances
– People who are homeless have more difficulty getting their basic needs met which increases risk of physical and mental health issues
– Children who are homeless, even if they are “doubling up” experience much higher rates of “stress” and often less school stability
– Adverse childhood experiences contribute to developmental delays and medical and mental health issues
– Many parents

– Communities need to identify the causes of homelessness in their area and begin to develop a safety net (FETCH MED)
– Food
– Encouragement/Empathy
– Transportation
– Clothing
– Housing/Shelter
– Medical, Dental and Mental Health Care
– Employment
– Dental Care


– Documenting Disability
– Sanctioned Homeless Encampments Initial Planning and Management Checklists